Low self-risk perception for HIV (9.9%), low consistent condom use with non-paid partners (18.6%) and wives (3%), low reported exposure to any interventions (25.6%) and low levels of ever having taken an HIV test (16.5%) make truckers an important bridge population requiring strengthened interventions.

BackgroundUsing data from two rounds of a cross-sectional, national-level survey of long-distance truck drivers, this paper examines the extent and trend of sexual risk behavior, prevalence of STI/HIV, and the linkage between exposure to HIV prevention programs and safe sex behavior.MethodsFollowing the time location cluster sampling approach, major transshipment locations covering the bulk of India’s transport volume along four routes, North-East (NE), North-South (NS), North-West (NW) and South-East (SE) were surveyed. First round of the survey was conducted in 2007 (sample size 2066) whereas the second round was undertaken in 2009-2010 (sample size 2085). Long distance truck drivers were interviewed about their sexual behaviors, condom use practices, exposure to different HIV prevention interventions, and tested for HIV, reactive syphilis serology, Neiserria gonorrhoeae and Chlamydia trachomatis. The key variable of this evaluation study - exposure to HIV prevention interventions was divided into three categories - no exposure, less intensive exposure and intensive exposure. Data were analyzed using multiple logistic regression methods to understand the relationship between risk behavior and exposure to intervention and between program exposure and condom use.ResultsThe proportion of truckers exposed to HIV prevention interventions has increased over time with much significant increase in the intensive exposure across all the four routes (NE: from 14.9% to 28%, P < 0.01; NS: from 20.9% to 38.1%; NW: 11.5% to 39.5%, P < 0.01; SE: 4.7% to 9.7%, P <0.05). Overall, the consistent condom use in sex with non-regular female partners too has increased over the time (paid female partners: from 67.1% to 73.2%, P <0.05; non-paid female partners: from 17.9% to 37.1%, P <0.05). At the aggregate level, the proportion tested HIV positive has declined from 3.2% to 2.5% in (p<0.10) and proportion tested positive for Syphilis too has reduced from 3.2% to 1.7% (p<0.05). Truckers who had sex with paid female partners (men at risk) were significantly more likely to get exposed to intensive program (aOR: 2.6, 95%CI 1.9-3.4) as compared to those who did not have sex with paid partners. Truckers who had sex with paid partners and exposed to intervention program were more likely to use condoms consistently (aOR: 2.1, 95% CI 1.2-3.7). The consistent condom use among respondents who travel through states with targeted interventions towards female sex workers was higher than those who travel through states with less intensive program among FSWs.ConclusionsThese evaluation study results highlight the ability of intensive program to reach truckers who have sex outside marriage with HIV prevention interventions and promote safe sex behaviors among them. Truckers who practice safe sex behaviors with an exposure to intensive program are less likely to suffer from STIs and HIV, which has implications for HIV prevention program with truckers’ population in India and elsewhere. The simultaneous targeted interventions among female sex workers app...

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The aim of this study was to investigate the suitability of the verbal autopsy technique in identification of cause of death during infancy. The study was carried out in 23 randomly selected clusters with 70 live births each, in districts Cuttack and Koraput of Orissa State. Each death occurrence during the reference period (1992-93) was investigated by the field investigator and cross checked by a medical professional using the same proforma. The probable cause of death in each case was analysed separately by the field investigator and then by the professionally qualified medical person. These were then compared using suitable statistical tests. A total of 179 infant deaths and 16 still births were reported by the field investigator in the area as compared to 183 deaths and 12 still births by professionally trained personnel. There was an agreement for 85.79 percent deaths and 75 percent still births. Disagreement was observed for fever, pneumonia, septicemia and meningitis as causes of deaths. It was more in rural area as compared to urban areas. The sensitivity and specificity of the tool were found to be 85.6 percent and 90.4 percent respectively. The technique is found to be cost effective, time saving and reasonably reliable. After intensive training the lay reporters can be used for recording easily recognizable signs and symptoms of infant deaths and thus help in monitoring infant mortality rate and causes of infant death in a vast country like India so as to achieve "health for all" by 2000 AD.